Insurers Oppose California Timely Access to Medical Care Standards in Regulatory Hearings

[courtesy of California Progress Report]

• Tuesday Hearing Brings Insurer and Provider Opposition to Consumer Protections
• Consumer Groups Say Delayed Care is Denied Care; Seek Stronger Regulations

By Anthony Wright
Executive Director of Health Access California

The Department of Managed Health Care (DMHC) held another hearing this Tuesday, September 18, 2007 in Sacramento to seek public comment on their second proposed revision to the new regulation governing timely access to care.

This long-delayed regulation is based on AB 2179 (Cohn) sponsored by Health Access California and passed in 2002. The inability of insured patients to get in to see a doctor or specialist is one of the most common complaints that consumer groups get. The lack of ability to get a medical appointment also leads people to unnecessarily go to the emergency room, leading to ER overcrowding and increased medical expenses. The law and regulation are intended to remedy these problems, and protect the value of the coverage for which people are paying.

DMHC wrote these regulations to require that consumers must be able to see a physician within certain prescribed time frames. Some examples specified in the regulation require that consumers see a primary care physician for urgent care within 24 hours, get an appointment for routine care with a primary care physician within 8 business days, or be referred to a specialist for urgent care within 72 hours. DMHC also outlined procedures for measuring performance, tracking compliance, and potential enforcement mechanisms.

INDUSTRY OPPOSITION: Health plans, providers, and their associations spoke against the Department’s regulation as written. They emphatically expressed their clear dislike for any time-elapsed standards. Some in provider community emphasized that this would result in “chaos in the delivery of health care in California” and would be “very burdensome to administer.” Many medical groups said this regulation would continue to drive doctors to retire or move to other states to practice.

Many plan representatives asserted that the implementation of this regulation would be extremely costly and would actually make timely access to care less available. Many providers objected to any tracking or monitoring of whether they actually met even the plan’s own internal standards for timely access and they objected to the imposition of any administrative sanctions or penalties for repeated failure to achieve this minimal performance standard.